Participant focus group information form

America's Promise Job Driven Grant Program Evaluation

FOCUS GROUP PARTICIPANT INFORMATION FORM

A. EDUCATION AND EMPLOYMENT HISTORY

A1. What is the highest level of education you have completed?

Mark one only

1 □ Did not complete high school

2 □ High school diploma or equivalent

3 □ Some college

4 □ Associate’s degree or vocational degree

5 □ Bachelor’s degree

6 □ Master’s degree or higher

Field of study:

A2. Do you have any specialized education or work credentials or certificates? Do not include a high school diploma, GED, or college degree.

1 □ Yes (specify)

0 □ No

A3. How many years of work experience do you have?

| | | years

A4. Are you currently working?

1 □ Yes

0 □ No GO TO A8, NEXT COLUMN

A5. What best describes your work status?

Mark one only

1 □ Working 30 hours per week or more

2 □ Working 1 to 29 hours per week

A5a. Even if you do not use them, are any of the following benefits available to you through your current job?

Mark All That Apply

1 □ Health insurance benefits

2 □ Paid sick days

3 □ A retirement savings or pension plan

A6. If you are currently working, what does your company do?

Industry:

Your length of time in industry:

Your length of time with current employer:

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 5 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is voluntary. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Office of the Chief Information Officer, Attention: Departmental Clearance Officer, 200 Constitution Avenue, N.W., Room N-1301, Washington, DC 20210 or email [email protected] and reference the OMB Control Number 12XX-XXXX. Note: Please do not return the completed form to this address.

A7. If you are currently working, what is your specific job?

Job:______________________________

Length of time in current job:

GO TO B1, NEXT PAGE

A8. If you are not currently working, what did your last company do?

Industry:

Your length of time in industry:

Your length of time with former employer:

A9. If you are not currently working, what was your last specific job?

Job:______________________________

Length of time in job:

A10. What was the reason this job ended

Reason:

GO TO B1, NEXT PAGE

B. [PROGRAM NAME] PARTICIPATION

These questions are about your experience with [PROGRAM NAME].

B1. Which of the following training, education and workforce services are you receiving/have you received through [PROGRAM NAME]?

Mark All That Apply

1 □ Case management and career counseling (i.e., staff person who provides 1:1 assistance)

2 □ Classroom training

3 □ On-the-job training, work internships, apprenticeships

4 □ Education

5 □ Career inventories or assessments to help you learn about a suitable career for your background and interests

6 □ Information about the job market, such as what types of jobs are available and what they require, or what careers you could go into and what they pay

7 □ Job readiness or soft skills training

8 □ Remediation or GED preparation

9 □ Vocational training

10 □ Job search and placement assistance, such as resume assistance or interview coaching

11 □ Job retention services

12 □ Other (specify)

B2. Which of the following support services are you receiving/have you received through [PROGRAM NAME]?

Mark All That Apply

1 □ Assistance with child care

2 □ Access to public benefits

3 □ Transportation assistance

4 □ Specialized services to accommodate disabilities

5 □ Other (specify)

B3. On average, how long have you received the services selected in B1 and B2?

| | | years | | | months | | | days

B4. What is the industry focus or pathway associated with your current training?

Industry/Pathway:

B5. Are you currently working towards a credential?

1 □ Yes (specify) _______________________

0 □ No

B6. Are you receiving services and support for training/education from sources other than [PROGRAM NAME]?

If yes, indicate those other sources.

Mark one only

1 □ Yes (indicate sources below)

Sources:

0 □ No

C. PARTICIPANT’S DEMOGRAPHICS

C1. What is your gender?

Mark one only

1 □ Female

2 □ Male

3 □ Other

C2. What is your age?

| | | years

C3. Are you Hispanic or Latino?

1 □ Yes

0 □ No

C4. What is your race?

Mark All That Apply

1 □ American Indian or Alaska Native

2 □ Asian

3 □ Black, African American

4 □ Native Hawaiian or other Pacific Islander

5 □ White

6 □ Other (specify)

C5. Do you have a mental or physical disability that limits your ability to work?

1 □ Yes

0 □ No

C6. Are you currently receiving or have you recently received unemployment insurance (UI) benefits?

Mark one only

1 □ Yes

0 □ No END

C7. How long have you been receiving UI benefits?

| | | years | | | months | | | weeks

C8. On what date did you last receive UI benefits?

| | | / | | | / | | | | |

month day year